MASSILLON, OH - A doctor’s decision not to perform a C-section - and her failure to properly advise her patient about the dangers of continuing a vaginal birth - resulted in an extremely prolonged second stage of labor as the unrelenting compressions caused vast trauma to the infant’s head. As the doctor forced the vaginal birth for more than four hours, ending with forceps and a vacuum, the fetal blood pressure could not overcome the increased intracranial pressure, and the prolonged lack of blood flow to the brain resulted in permanent brain damage.

This extremely complex mechanism of injury is called Cranial Compression Ischemic Encephalopathy (CCIE), also known as Traumatic Ischemic Encephalopathy. It is a hotly debated issue within both the medical and legal communities, and Michael Becker, Esq., and David Skall, Esq., needed jurors to understand how it caused their client’s irreversible brain injury.

This animation demonstrates how CCIE causes brain injury.

The Defense argued that the only recognized birth-related brain damage involved disruption of blood flow from the placenta or umbilical cord. We needed to show how localized trauma and compression of the fetal head during labor and delivery can dangerously impair blood flow to the brain without any direct compromise of flow through the placenta or umbilical cord. The animations helped us demonstrate that mechanism of injury in a way that was easy for jurors to understand.

David Skall, Esq., Becker Law Firm Co., L.P.A., Cleveland, OH

The baby was born with very low Apgar scores, and his heart-rate, breathing, and skin color were very poor. The skull showed extensive swelling on the scalp from pushing against the pelvis. He was diagnosed multiple times as having Hypoxic Ischemic Encephalopathy (HIE) as the result of a “difficult delivery.” But the Defendant chose to downplay the swelling of his scalp (known as Caput Succedaneum). The baby remained in the hospital for 11 days before being discharged with a lifetime of disabilities.

15 months later, a CT film showed a watershed pattern of injury and tissue damage on both sides of the baby’s brain. This type of injury is known to occur when the brain receives insufficient oxygen and blood for an extended period of time. However, it wasn’t until age eight that an MRI again confirmed the watershed brain injury, which logically could have only occurred at birth.

The Defense argued that this mechanism of injury was theoretical, claiming that localized pressure to the brain is incapable of producing watershed brain damage. They went so far as to request that the Court prohibit any evidence or testimony concerning CCIE. The Defense claimed that the only acceptable mechanism of injury for this type of damage was Systemic Asphyxia caused by a disruption to the placenta - despite a complete lack of evidence supporting the Defense’s theory in that no other organs suffered damage and the baby’s blood was not highly acidic at birth.

The evidence was eventually admitted however with the Court stating that the reliability requirement of admitting scientific expert testimony “should not be used to exclude all evidence of questionable reliability, nor should a court exclude such evidence simply because the evidence is confusing,” - citing Miller et al., Appellants, v. Bike Athletic Company et al. Co., 80 Ohio St.3d 614.

Once their expert’s testimony was admissible, Mr. Becker and Mr. Skall needed powerful visuals to help simplify the most complex issues concerning CCIE so they could focus on conveying how and why the doctor’s decision to prolong and force this vaginal birth directly contributed to their client’s brain injury. We equipped them with two animations and a DigiStrip that would achieve the following visual objectives:

Demonstrate what this CCIE mechanism of injury looks like, and how it causes watershed brain damage similar to what was suffered by the Plaintiff.

Show how the Defendant’s decision not to change the birth plan - despite numerous risk factors and signs of distress - prolonged this mechanism of injury.

Chart the clear abnormalities in the Fetal Monitoring Strip that the Defendant failed to recognize throughout this dangerously prolonged labor.

Exhibit A: Demonstrating the Mechanism of Injury

When the Defense’s goal is to confuse and complicate your theory of liability, animation is the most powerful way to simplify and make clear the complex issues you need the jury to understand. This first animation demonstrates exactly what Compression Ischemic Encephalopathy (CCIE) looks like, and how it results in brain damage.

The first animation demonstrates this contentiously complex mechanism of injury in a way jurors could easily understand.

The scene opens up with the baby at +2 Station and demonstrates how contractions from the mother relentlessly crushes the infant’s fragile head, preventing the flow of blood from reaching the brain. The prolonged decrease in blood flow (ischemia) causes damage to the brain without damaging other organs. The animation then concludes with a list of risk factors and signs of distress that were neglected.

Exhibit B: Showing Clear Negligence in Prolonging this MOI

Once we had established how this mechanism of injury causes brain damage, the next animation establishes exactly how the Doctor prolonged this dangerous situation for hours without considering obvious signs of distress.

The next animation shows how the medical negligence clearly prolonged the injury.

The mother was instructed to push for four straight hours with little-to-no-progress before the Doctor decided to use a vacuum and then forceps to force the baby through the birth canal. The animation shows how the baby’s skull began molding and swelling as his head was forced against the pelvis for hours. The animation then concludes with two camera angles showing how the baby’s head was abnormally malpositioned, and how that position put direct pressure on the occipital lobe.

Exhibit C: Charting the Red Flags that Should Have Been Recognized

Once we had demonstrated the mechanism of injury and the medical negligence responsible for prolonging this injury, we needed to chart the obvious abnormalities that should have been recognized in the Fetal Monitoring Strip.

The DigiStrip is an interactive timeline that is customized for any case where fetal heart monitoring is a critical focal point.

The Digistrip® is a High Impact product we build and customize to present Fetal Monitoring Strips within a virtual workspace that gives you full interactive control over the timeline.

Scroll backward and forward in time.

Zoom in and out of vital points of interest.

Highlight a multitude of specific details using multi-colored highlighters.

Draw attention to critical points of contention using a set of drawing tools.

Annotate key concepts throughout the timeline using custom labels.

Bookmark important points in time you can skip to during your presentation.

Command complete control over the presentation of your evidence.

High Impact’s team of visual strategists, artists and developers can build and customize your digital presentation for any case involving personal injury, medical malpractice, birth trauma - or any subject involving complex information.